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Purpose <p>Hip fractures in the elderly are associated with high 1-year mortality rates. Identifying reliable prognostic markers is essential for improving outcomes. The albumin haemoglobin index (AHI), previously studied in gastrointestinal surgery, has not been evaluated in hip fracture patients. This study aimed to assess AHI’s prognostic significance in predicting 1-year mortality, with additional hazard model analyses at 3 and 6&#xa0;months, and compared its performance to other preoperative blood parameters.</p> Method <p>This retrospective study included 775 patients aged ≥ 65&#xa0;years who underwent hip fracture surgery from January 2020 to December 2021. Patients underwent a Fracture Liaison Service. Preoperative blood parameters, including haemoglobin (Hb), albumin (Alb), creatinine (Cr), alkaline phosphatase (ALP), alanine aminotransferase (ALT), red cell distribution width (RDW), and RDW/albumin ratio (RAR), were analysed. AHI was calculated as the product of albumin and haemoglobin. Receiver operating characteristic (ROC) curves assessed the prognostic performance of blood predictors for 1-year mortality, while Cox proportional hazards models evaluated the association between preoperative blood parameters and mortality risk at 3, 6, and 12&#xa0;months postoperatively.</p> Results <p>The 1-year mortality rate was 16.6% (129/775). ROC analysis showed preoperative AHI as a strong predictor of 1-year mortality (AUC: 0.75, 95% CI: 0.71–0.80, <i>p</i> &lt; 0.001), comparable to RAR (AUC: 0.77, 95% CI: 0.73–0.82) and superior to RDW (AUC: 0.72, 95% CI: 0.67–0.77). Cox models confirmed AHI’s predictive value for 1-year mortality (adjusted HR: 3.67, 95% CI: 2.44–5.51, <i>p</i> &lt; 0.001), similar to RAR (adjusted HR: 3.94, 95% CI: 2.62–5.90) and higher than RDW (adjusted HR: 2.12, 95% CI: 1.43–3.14). AHI &lt; 3331, RAR &gt; 0.468, and RDW &gt; 14.15% were significant predictors, with consistent trends at 3 and 6&#xa0;months in hazard models.</p> Conclusion <p>AHI is a potential novel predictor of 1-year mortality in elderly hip fracture patients, with prognostic performance comparable to RAR and superior to RDW. Its integration into preoperative assessments may enhance risk stratification and guide interventions to reduce mortality, offering a simple and accessible biomarker for clinical use.</p> Summary <p>Preoperative albumin haemoglobin index (AHI) demonstrated strong prognostic accuracy for 1-year mortality in elderly hip fracture patients (AUC: 0.75, 95% CI: 0.71–0.80, <i>p</i> &lt; 0.001; adjusted HR: 3.67, 95% CI: 2.44–5.51, <i>p</i> &lt; 0.001), with an optimal cutoff value of &lt; 3331. AHI is a potential novel biomarker for predicting 1-year mortality in this population.</p>

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A potential novel predictor of 1-year mortality in elderly hip fracture patients-albumin haemoglobin index

  • 期刊论文

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  • 发表日期：

    2025年6月10日

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  • Yu Hei Choi,
  • Pui Yan Wong,
  • Man Ki Fong,
  • Wai Wang Chau,
  • Wing Hong Liu,
  • Chaoran Liu,
  • Ning Zhang,
  • Ning Tang,
  • Chun Sing Chui,
  • Wing Hoi Cheung,
  • Ronald Man Yeung Wong

摘要

Purpose

Hip fractures in the elderly are associated with high 1-year mortality rates. Identifying reliable prognostic markers is essential for improving outcomes. The albumin haemoglobin index (AHI), previously studied in gastrointestinal surgery, has not been evaluated in hip fracture patients. This study aimed to assess AHI’s prognostic significance in predicting 1-year mortality, with additional hazard model analyses at 3 and 6 months, and compared its performance to other preoperative blood parameters.

Method

This retrospective study included 775 patients aged ≥ 65 years who underwent hip fracture surgery from January 2020 to December 2021. Patients underwent a Fracture Liaison Service. Preoperative blood parameters, including haemoglobin (Hb), albumin (Alb), creatinine (Cr), alkaline phosphatase (ALP), alanine aminotransferase (ALT), red cell distribution width (RDW), and RDW/albumin ratio (RAR), were analysed. AHI was calculated as the product of albumin and haemoglobin. Receiver operating characteristic (ROC) curves assessed the prognostic performance of blood predictors for 1-year mortality, while Cox proportional hazards models evaluated the association between preoperative blood parameters and mortality risk at 3, 6, and 12 months postoperatively.

Results

The 1-year mortality rate was 16.6% (129/775). ROC analysis showed preoperative AHI as a strong predictor of 1-year mortality (AUC: 0.75, 95% CI: 0.71–0.80, p < 0.001), comparable to RAR (AUC: 0.77, 95% CI: 0.73–0.82) and superior to RDW (AUC: 0.72, 95% CI: 0.67–0.77). Cox models confirmed AHI’s predictive value for 1-year mortality (adjusted HR: 3.67, 95% CI: 2.44–5.51, p < 0.001), similar to RAR (adjusted HR: 3.94, 95% CI: 2.62–5.90) and higher than RDW (adjusted HR: 2.12, 95% CI: 1.43–3.14). AHI < 3331, RAR > 0.468, and RDW > 14.15% were significant predictors, with consistent trends at 3 and 6 months in hazard models.

Conclusion

AHI is a potential novel predictor of 1-year mortality in elderly hip fracture patients, with prognostic performance comparable to RAR and superior to RDW. Its integration into preoperative assessments may enhance risk stratification and guide interventions to reduce mortality, offering a simple and accessible biomarker for clinical use.

Summary

Preoperative albumin haemoglobin index (AHI) demonstrated strong prognostic accuracy for 1-year mortality in elderly hip fracture patients (AUC: 0.75, 95% CI: 0.71–0.80, p < 0.001; adjusted HR: 3.67, 95% CI: 2.44–5.51, p < 0.001), with an optimal cutoff value of < 3331. AHI is a potential novel biomarker for predicting 1-year mortality in this population.